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Biomedical subjects

A Wild

Publications and source records attributed to A Wild.

At least 109 records · Page 6Linked to original sources
PubMedDate not supplied

[Staged reposition and fusion with external fixator in spondyloptosis].

PROBLEM: Is the staged reduction by an external fixateur and combined fusion of slipping vertebra an adequate surgical treatment for lumbar spondyloptosis? METHODS: 11 patients with symptomatic lumbar spondyloptosis were treated using a technique of slow reduction and combined posterior and anterior approach. The first stage consists of a posterior approach with the application of the external fixateur. After staged reduction the anterior and posterior fusion are performed. All patients were pre- and postoperatively classified by radiological and clinical criteria. We report improvements in pain, activities of daily live, and cosmetic appearance. The average follow-up was over three years. RESULTS: Postoperatively one patient failed to reduce, and one developed a subsequent L4/L5 spondylolisthesis. All patients showed a solid spondylodesis with no significant loss of reduction. There was no patient with any neurological deficit. The mean correction of the slipping at follow-up was 84.5%. 9 patients were satisfied with the result. CONCLUSION: With gradual instrumented reduction by external fixateur, an anatomic reduction is nearly obtained and excellent clinical results in the treatment of spondyloptosis can be achieved.

Adolescent↗
PubMedDate not supplied

[Medical-insurance aspects of atlantoaxial instability in children].

INTRODUCTION: An os odontoideum is mostly diagnosed coincidentally on the basis of neurological symptoms or painful movement of the cervical spine. Diagnostic work-up and therapy are currently subjects of controversial discussion in the literature. CASE: Our report is about an eleven-year-old boy with an unknown os odontoideum, who developed neurological symptoms with tetraparesis after a fall from 1.5 m height. Conventional X-ray examination resulted in the diagnosis of a suspected dens fracture, MRI showed atlanto-axial instability and an os odontoideum with significant dural sack compression but no signs of acute bony or ligamentous lesion. CONCLUSION: Because of the importance concerning not only medical but also legal/insurance aspects, a possible coincidental finding of an os odontoideum versus a dens fracture must be included in the differential diagnosis. In the case of an os odontoideum without instability in children, conservative therapy is justified after due enlightenment regarding possible risks. In the event of neurological symptoms and/or persistent instability the authors advocate early surgical stabilization even in patients with little infirmity, particularly in view of the possible consequences.

Accidental Falls↗
PubMedDate not supplied

[Primary synovial chondromatosis of the shoulder].

AIM: To demonstrate the various patterns of primary synovial chondromatosis (PSC) around the shoulder and to discuss a therapeutic algorithm. METHOD: In this retrospective study, 6 patients with histologically proven PSC were operated on. The diagnosis was based on clinical examination, plain X-rays, ultrasonography and MRI in 5/6 patients. Also, a histological examination was done in all cases. According to the localisation of the disease, surgery was done by endoscopy alone, endoscopy together with open surgery or direct open surgery. RESULTS: In one case each, we saw an isolated disease of the subacromial bursa or the gleno-humeral joint. In two cases, we found an intraarticular affection together with the biceps tendon sheath. The other two patients showed a massive periarticular deposition of loose bodies together with a defect of the rotator cuff. All patients with intraarticular disease (5/6) showed different stages of chondromalacia. In 5 of 6 patients all bodies could be removed at surgery. At follow-up after 36 months the patients subjectively rated the result as satisfactory to excellent. In the patients with total removal of the bodies, no recurrences were seen on plain X-ray or ultrasonography. CONCLUSION: PSC around the shoulder appears with a variable pattern. According to the possible late complications described in the literature (i. e., secondary osteoarthritis, involvement of the rotator cuff and secondary malignant transformation), we find operative treatment justified. Surgery addressing removal of loose bodies and partial synovectomy allows good results. The operative approach (endoscopy or open surgery) is related to the localisation and severity of the condition.

Adult↗
PubMedDate not supplied

[Medical-legal aspects in fractured ceramic liners after implantation of a hip endoprosthesis].

We report the case of a male patient after implantation of a thrust plate endoprosthesis to discuss reliable questions concerning the insurance and liability fields. The indication for implantation of this type of endoprosthesis should be decided critically. To prevent an early implant failure, both articulating ceramic partners - the liner and the femoral head - should be exchanged in any case of doubt during a hip revision surgery. In case of an implant failure, a surface analysis of the broken fragments can show signs of material insufficiencies. A detailed preoperative consent of the patient combined with an exact documentation is necessary to prevent potential medical claims by the patient, and also increases the compliance and reduces the costs for the health system.

Adult↗
PubMedDate not supplied

[Clinical and radiological short- and mid-term results of triple pelvic osteotomy according to Tönnis in adolescents and adults].

AIM: We report our clinical and radiological results after triple pelvic osteotomy according to Tönnis and accompanying femoral osteotomies in selected cases. METHOD: 48 patients were evaluated in a retrospective study with an average follow-up to 2 years and 9 months. RESULTS: In 68 % of our patients excellent to good results in the Harris Hip Score were achieved. We could significantly decrease pain awareness. The CE angle improved significantly from 10.6 degrees to 32.2 degrees and the acetabular angle of the weight-bearing zone according to Bombelli from 20.8 degrees to 3.8 degrees at the last follow-up. The VCA angle according to Lequesne and de Seze improved from 18.6 degrees to 33.5 degrees. Non-union of the ischial or the pubic bone developed in 7 cases as a relevant complication. CONCLUSION: On the basis of our results and the literature, the triple pelvic osteotomy according to Tönnis can be recommended for the treatment of acetabular dysplasia in adolescents and adults.

Acetabulum↗
PubMedDate not supplied

[Advantages of biomatrices in chondrogenesis of pluripotent mesenchymal stem].

AIM: The autologous in vitro expansion of chondrocytes is a new method for the treatment of localized cartilage defect zones in humans. In the past several investigators have shown the occurrence of mesenchymal stem cells (MSC) in human bone marrow, periosteum and somite mesoderm. Moreover it has been shown that these progenitor cells are able to differentiate into chondral tissue under special in vitro conditions. The following study shows current possibilities and borders of a chondrogenetic stem cell therapy. Furthermore advantages and disadvantages of different cellular biomatrix carriers are described, cartilage tissue engineering-related problems are discussed and possible solutions were pointed out. METHODS: A literature investigation served for evaluation of the present clinical and experimental data. Furthermore our own cell culture experiences were considered. RESULTS: Until now there exists no clinical concept using the potential of MSC for cartilage tissue engineering. Reasons are the lack of biomechanical and histological stability and handling problems of the cultivated cartilage tissue, especially the difficulties to fix and secure the transplant in the cartilage defect zones in situ. CONCLUSION: The systematic investigation of biomatrices by chondrogenic progenitor cell culture systems may lead to important data for the evaluation of the chondrogenic potency biomatrices.

Cell Differentiation↗
PubMedDate not supplied

[One- or two-step instrumentation for thoracolumbar scoliosis due to myelomeningocele?].

AIM: This investigation evaluates patients with MMC who underwent a two-stage anterior-posterior correction and stabilisation of thoracolumbar scoliosis due to myelomeningocele. The data were compared with the few reported series of one-stage versus two-stage surgery in the literature. METHOD: From 1.7.1992 to 30.6.1995, 11 consecutive patients with severe thoracolumbar scoliosis due to myelomenigocele were admitted at our hospital. The mean age at operation was 12 years nine months (range nine years nine to 14 years six months). All patients underwent a two-stage anterior and posterior spinal instrumentation. The patients were pre- and postoperatively evaluated. RESULTS: All patients were followed for a mean of 4 years 11 months (range 42 months to 88 months) from the time of the second stage procedure. Preoperatively the mean scoliosis angle was 82 degrees (range 55 degrees to 110 degrees ), this was reduced to a mean of 31 degrees (range 8 degrees - 70 degrees ), at final follow-up, the correction had deteriorated slightly to a mean of 35 degrees (range 12 degrees - 80 degrees ). No patient had increased neurological deficit or showed other major complications, i. e., infection, sepsis due to immunologic disorders at the time of the operation. CONCLUSION: We believe that with the two-stage anterior and posterior instrumentation an effective correction of the scoliosis can be achieved. Compared to other studies this report confirms the low morbidity rate and emphasise the good results of a two staged procedure.

Adolescent↗
PubMedDate not supplied

[Kyphoscoliosis in Wiedemann-Rautenstrauch-syndrome (neonatal progeroid syndrome)].

AIM: The Wiedemann-Rautenstrauch syndrome (neonatal progeroid syndrome, WR syndrome) is a rare autosomal recessive disorder including premature aging already at birth. Most of the patients show an aged face, a craniofacial dysmorphism, decreased subcutaneous fat tissue, a significant developmental delay, and have a short life expectation. We present the second patient described in literature reaching an age of 16 years. Furthermore this patient developed a progressive scoliosis during childhood which to our knowledge has not been reported before among individuals affected by Wiedemann-Rautenstrauch syndrome. The pathogenetic features of the spinal deformity are discussed and the operative management is described. METHOD: The patient underwent a three-stage correction of her spinal deformity (anterior thoracic and lumbar release and posterior release, correction of the deformity with instrumentation and fusion) supported by Halo traction and physiotherapy. RESULTS: At the latest follow-up 12 months postoperatively the patient showed a stable correction from 78 degrees to 38 degrees in the frontal plane with physiologic sagittal alignment both clinically and radiologically. CONCLUSION: The scoliosis of our patient with Wiedemann-Rautenstrauch syndrome showed radiologically and clinically the characteristics of a neuromuscular curve. Since the curve showed a significant progression and high rigidity operative correction and fusion was indicated. We recommend a staged operative management to minimize the high risks of the operations and possible complications from cardiological and respiratory dysfunction associated with WR syndrome.

Adolescent↗
PubMedDate not supplied

[Osteonecrosis and HELLP-Syndrome].

BACKGROUND: In 25 % of patients who develope gestosis a Hemolysis- Elevated- Liver-enzymes-and- Low- Platelet-count-Syndrome (HELLP-Syndrome) may occur, which is characterized by activation of the coagulation mechanism and bone marrow alterations. Besides this therapeutical steroid application and an elevated age of primigravidity are responsible for an increased osteonecrosis risk in women, too. Because of anatomical and biomechanical reasons the highest incidence of pregnancy-associated osteonecrosis are the subchondral areas of the femoral epiphysial head. PATIENTS/METHODS: In this investigation data of pathogenesis, diagnostic work up and therapy in HELLP-associated osteonecrosis are reviewed and discussed based on a case report. We report of a 37-year old HELLP-patient showing bilateral femoral head osteonecrosis, who sustained a proximal femur fracture after bone marrow core decompression surgery. RESULTS/CONCLUSIONS: In pregnant patients with joint or bone associated pain an early MRI screening is recommended to detect osteonecrosis at early stages. This allows for therapeutic procedures which may be successful at early stages. If steroids are applicated for HELLP-treatment, the risk of osteonecrosis is elevated. DISCUSSION: Only early stages of osteonecrosis can be treated curatively. Sometimes it can be difficult to differentiate between early osteonecrosis stages, a bone marrow edema syndrome and a transient osteoporosis.

Adult↗
PubMedDate not supplied

[Occurrence of a segmental kyphosis after laminectomy of C2 for an aneurysmatic bone cysts--course and treatment strategy].

HISTORY: A 9-year-old girl suffered from an enlarging tumor in the lamina of the axis. After resection of the aneurysmatic bone cyst via laminectomy of C2 an anterior plate-fusion of C2/3 was done. Instead of a correctly placed ventral cervical plate, an adjacent instability of the level C3/4 with kyphosis and subluxation of the facet joints was seen at follow-up. COURSE OF TREATMENT: After reposition over a hypomochlion retention was achieved with a halo body-jacket. Two weeks later the level C3/4 was stabilized by posterior instrumentation. After almost two years the patient has no complaints and the radiological controls show correctly placed instrumentation and increasing bony fusion at the levels C2/3 and C3/4. CONCLUSION: Especially in children and adolescents laminectomy of a cervical vertebra often leads to kyphotic deformities. When using a posterior approach for surgery of intraspinal lesions or in case of tumors of the dorsal elements of the spine, the laminae and posterior structures should be preserved or, respectively, reconstructed for restoration of traction and tension mechanisms. This is of essential relevance for biomechanical stability and maintenance of the sagittal profile of the spine.

Bone Cysts, Aneurysmal↗
PubMedDate not supplied

[Computer-assisted periacetabular triple osteotomy for treatment of dysplasia of the hip].

AIM: Besides general risks, reorienting periacetabular osteotomies include the risks of over- or under-correction. Therefore, intraoperative computer-assisted control of the pelvic fragment may allow for precise reorientation of the acetabulum in all planes. METHODS: The advantages and problems of a computer assisted periacetabular osteotomy are demonstrated in a 19 year old female with spastic paresis and severe secondary dysplasia of the hip over a postoperative follow up period of 2 years. Because of progressive subluxation of the left femoral head with initial degenerative changes of the hip joint a pelvic triple osteotomy as described by Tönnis and an intertrochanteric derotation-varus osteotomy were performed. The intraoperative control of the acetabular position was optimized by CT based navigation. To compare and evaluate the pre- and postoperative clinical and functional outcome, X-rays, CT scans and a gait analysis were applied. RESULTS: The computer assisted orthopedic surgery (CAOS) technique allows for precise intraoperative control following reorientation of the acetabular fragment in all three planes. The pre- and postoperative clinical and radiological findings were compared and the result was classified as good. CONCLUSION: Although the costs and logistics for pelvic osteotomies are increased by CAOS technology, the authors favor this technique for corrective surgery of complex acetabular deformities, although individual parameters need to be considered in each patient.

Acetabulum↗
PubMedDate not supplied

[Correction of forearm deformities in children with multiple cartilaginous osteochondromas].

AIM: Deformity of the forearm with shortening and bowing is common in children with multiple cartilaginous osteochondromas. The objective of this study was to evaluate the benefit of ulnar lengthening using an external fixateur in these patients. METHOD: 9 patients (10 cases) underwent surgery of the forearm between 1995 and 2001 and were evaluated using a standard protocol. The mean follow-up was 33.6 months, the mean age at operation 8.9 years. All patients were treated with ulnar lengthening, in 6 cases combined with an excision of the osteochondromas. RESULTS: Four out of ten patients did show an improvement in postoperative forearm rotation, two deteriorated and 4 presented unchanged. Wrist motion improved in 7 patients and remained unchanged in 3. The postoperative radial articular angle showed an improvement in 6, the carpal slip in 9 of the patients. The preoperative radial head dislocation in one patient remained unchanged postoperatively. CONCLUSION: The authors advocate this therapeutic concept for the correction of forearm deformity in multiple hereditary osteochondromas to prevent a progression of the deformity and to establish carpal stability. A significant improvement of forearm and wrist function could not be reached.

Bone Lengthening↗
PubMedDate not supplied

[Preoperative halo-traction in severe paralytic scoliosis].

AIM: During the past decades the treatment of severe paralytic scoliosis has developed towards surgical treatment. However there is controversial discussion about the need of pre-operative Halo-traction. The aim of this study was to built two groups of patients -- one group with and another one without pre-operative Halo-traction -- and to compare the results after surgical correction of scoliotic deformity with data from literature. METHOD: Between 2000-2003 twenty-five patients with severe neuromuscular spine deformity were treated surgically. Eight patients had preoperative Halo-traction, seventeen patients underwent directly operative correction and instrumentation. The evaluation included the pre- and postoperative X-rays as well those after Halo-traction before surgery. RESULTS: In the group without Halo-traction the scoliotic angle according to Cobb was reduced from 77 degrees to 33 degrees on average (mean correction of 44 degrees [57 %]). In the group with Halo-traction scoliosis was reduced from 85 degrees to 33 degrees on average (mean correction of 52 degrees [61 %]). CONCLUSION: The preoperative Halo-traction in patients with severe neuromuscular scoliosis indeed leads to radiologically higher correction, but this is not significant (p = 0.19) and only in single cases clinically relevant. In our point of view except from specific indications Halo-traction should not be applied in general as a standard procedure.

Adolescent↗
PubMedDate not supplied

[Complex reconstruction of subluxated and dislocated hip joints in spastically handicapped children].

QUESTION: Will surgical reconstruction of subluxated or dislocated hip joints in children with cerebral palsy lead to stable reduction and painless hips? Is there any positive influence on psychomotoric development of the children and on trunk and pelvic symmetry as well as on daily hygienic care after successful reduction of unstable hip joints in spastic children? MATERIALS AND METHODS: Thirty hip joints in 26 children with cerebral palsy were operated applying the same complex reconstruction method of the hip joint. Fifteen of these children with 17 operated hip joints fulfilled a minimum follow up period of 3 years were evaluated continuously in this study. The parents and physiotherapists answered a questionnaire, all patients were examined clinically and pelvic anteroposterior and lateral radiographs were obtained. RESULTS: The mean age at surgery was 6 years, the minimum follow up 3 years (3-10 years). All hip joints were preoperatively decentered, 6 subluxated, 11 complete dislocated. At follow-up 15 of 17 were persistently reduced. The postoperative results were graded by the parents as excellent and good in eleven, satisfying in four and in two patients as poor. The radiographic evaluation showed an significant improvement of the CE-, AC- and neck shaft angle. CONCLUSION: Reconstruction of decentered hips will lead to stable reduction and painless hips at least in mid term follow-up. Symmetrically centered hip joints are mandatory for a pelvic and spinal symmetry and may contribute for an optimal of psychomotoric development.

Cerebral Palsy↗
PubMedDate not supplied

[The course of adjuvant disease in rats of the strain AF/Han-EMD-SPF].

The development of articular and osseous lesions in AF/Han-EMD-SPF breed rats with adjuvant disease was studied by morphological methods. At the noninjected side arthritic lesions with eventual progressive joint destruction appeared about the tenth day after adjuvant injection. Nearly simultaneously an incipient tumorous osteomyelitis in the bones both of injected and non-injected side was observed. Since epitheloid granuloma were also seen in the periarticular tissue of some animals the authors believe that all lesions in adjuvant arthritis are caused by a widespread dissemination of the injected complete adjuvant.

Adjuvants, Immunologic↗
PubMedDate not supplied

[Destruction of cartilage in the adjuvants disease of the rat].

The structure of cartilage in rats with adjuvant disease was investigated lightmicroscopically and by scanning electron microscopy. Severe destruction of the cartilage with formation of lacunae only was observed in areas previously covered by pannus. However, outside the pannus differences between normal animals and animals with arthritis also were observed. In adjuvant treated animals a more fibrillar structure of the surface was seen as compared with untreated rats. This more fibrillar structure may be due to a loss of mucopolysaccharides. The severe destruction of cartilage must be related to the action of collagenase which only acts in areas with a close contact between cartilage and pannus.

Animals↗